Abstract 99: Time to Treatment with Intravenous Tissue Plasminogen Activator and Outcome from Acute Ischemic Stroke in the National US GWTG-Stroke Population
Background: Randomized clinical trials have shown that the benefit of intravenous (IV) tissue-type plasminogen activator (tPA) in acute ischemic stroke is time dependent. However, the generalizability of clinical trial findings to routine practice is uncertain; and modest sample sizes have limited characterization by trial data of the degree to which onset to treatment (OTT) time influences outcome from thrombolytic stroke therapy.
Methods: We analyzed data from 58,353 acute ischemic stroke patients treated with tPA within 4.5 hours of symptom onset in 1395 hospitals participating in the Get With the Guidelines-Stroke Program from April 2003, to March 2012. Main outcome measures were 1) independent ambulation at discharge, 2) discharge to home, 3) in hospital mortality, and 4) symptomatic intracerebral hemorrhage. Univariate and multivariate stepwise logistic regression modeling was employed to evaluate the independent impact of OTT time on outcome.
Results: Among the 58,353 tPA-treated patients, median age was 72, 50.3% were female, median OTT was 144 minutes (IQR=115-170), and 9.3% (5404) had OTT 0- 90 minutes, 77.2% (45,029) had OTT 91-180 minutes, and 13.6% (7920) had OTT 181-270 minutes. Pretreatment NIHSS, documented in 87.7% of patients, was median 11 (IQR 6-17). Multivariate analysis of NIHSS documented cases, showed shorter OTT time was associated with increased odds of independent ambulation at discharge and discharge to home, and reduced odds of in-hospital mortality and symptomatic intracerebral hemorrhage (Table 1).
Conclusions: In national US clinical practice, earlier ischemic stroke treatment with IV tPA is associated with more frequent independent ambulation at discharge and discharge to home, and reduced SICH and mortality. These findings support intensive efforts to accelerate patient presentation and treatment initiation, such as Target Stroke, to maximize benefit of thrombolytic therapy.
- © 2012 by American Heart Association, Inc.